Method: After unsolicited referrals from their psychiatrists
and careful consideration by the Massachusetts General Hospital Cingulotomy
Assessment Committee (MGH-CAC), 5 patients were treated with limbic leucotomy.
Their primary DSM-IV psychiatric diagnoses were either obsessive-compulsive
disorder or schizoaffective disorder. Comorbid severe, treatment-refractory
self-mutilation was an additional target symptom. Outcome was measured by an
independent observer using the Clinical Global Improvement, Current Global Psychiatric-Social
Status Rating, and DSM-IV Global Assessment of Functioning scales in addition
to telephone interviews with patients, families, their psychiatrists, and treatment
teams. The mean postoperative follow-up period was 31.5 months.

Results: All measures indicated sustained improvement in 4 of
5 patients. In particular, there was a substantial decrease in self-mutilation
behaviors. Postoperative complications were transient in nature, and postoperative
compared with preoperative neuropsychological assessments revealed no clinically
significant deficits.

Conclusion: In carefully selected patients as described in this
report, limbic leucotomy may be an appropriate therapeutic consideration for
self-mutilation associated with severe, intractable psychiatric disorders.